Hemorrhagic shock represents a major cause of preventable mortality following trauma. Identifying shock early on the scene is critical for survival, particularly within resource-limited settings like Thailand, where prehospital blood products are unavailable. Although several scoring tools exist, uncertainty remains regarding which tool offers the optimal diagnostic accuracy for predicting massive transfusion (MT) and early death in this specific setting.

This research aimed to compare the predictive performance of five prehospital scoring tools – Shock Index (SI), Reverse Shock Index multiplied by Glasgow Coma Scale (rSIG), National Early Warning Score (NEWS), Assessment of Blood Consumption (ABC), and Revised Assessment of Bleeding and Transfusion (RABT) – for predicting MT and 24-hour mortality.

This retrospective prognostic accuracy study included adult trauma patients transported by Emergency Medical Services (EMS) to a university-affiliated Level 1 Trauma Center in Bangkok from January 2019 through December 2024. The primary endpoint was MT; the secondary endpoint was 24-hour mortality. Area Under the Receiver Operating Characteristics (AUROCs) assessed discrimination and the DeLong test compared performance among scores.

A total of 584 eligible patients were included, of whom 63 (10.8%) required MT. The NEWS demonstrated the highest discriminatory power for MT (AUROC 0.84; 95% CI, 0.79–0.90), followed by rSIG (AUROC 0.83; 95% CI, 0.76–0.90) and SI (AUROC 0.78; 95% CI, 0.72–0.86). In contrast, trauma-specific scores showed lower performance, with AUROCs of 0.69 for ABC and 0.74 for RABT. For 24-hour mortality, NEWS and rSIG demonstrated excellent discrimination (AUROCs of 0.93 and 0.91, respectively). At a cut-off of four or higher, NEWS showed a sensitivity of 81.0% for MT, while rSIG ≤ 16 provided a balanced sensitivity of 74.6% and specificity of 88.5%.

Both NEWS and rSIG predicted MT and 24-hour mortality more accurately than ABC and RABT. These tools may support early pre-arrival notification and blood bank preparation without delaying rapid transport.

Humanitarian mine action (HMA) stakeholders have an organized presence with well-resourced medical capability in many conflict and post-conflict settings. Humanitarian mine action has the potential to positively augment local trauma care capacity for civilian casualties of explosive ordnance (EO) and explosive weapons (EWs). Yet at present, few strategies exist for coordinated engagement between HMA and the health sector to support emergency care system strengthening to improve outcomes among EO/EW casualties.

A scoping literature review was conducted to identify records that described trauma care interventions pertinent to civilian casualties of EO/EW in resource-constrained settings using structured searches of indexed databases and grey literature. A 2017 World Health Organization (WHO) review on trauma systems components in low- and middle-income countries (LMICs) was updated with additional eligible reports describing trauma care interventions in LMICs or among civilian casualties of EO/EWs after 2001.

A total of 14,195 non-duplicative records were retrieved, of which 48 reports met eligibility criteria. Seventy-four reports from the 2017 WHO review and 16 reports identified from reference lists yielded 138 reports describing interventions in 47 countries. Intervention efficacy was assessed using heterogenous measures ranging from trainee satisfaction to patient outcomes; only 39 reported mortality differences. Interventions that could feasibly be supported by HMA stakeholders were synthesized into a bundle of opportunities for HMA engagement designated links in a Civilian Casualty Care Chain (C-CCC).

This review identified trauma care interventions with the potential to reduce mortality and disability among civilian EO/EW casualties that could be feasibly supported by HMA stakeholders. In partnership with local and multi-lateral health authorities, HMA can leverage their medical capabilities and expertise to strengthen emergency care capacity to improve trauma outcomes in settings affected by EO/EWs.